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NPI Code Detail

MEDICARE: REBECCA WHITAKER JACKSON

MEDICARE: REBECCA WHITAKER JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst19-75058UT

General Provider Information

NPI Number : 1053885285
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA WHITAKER JACKSON
Provider Business Mailing Address
First Line : 972 N 370 E
Second Line :
City : AMERICAN FORK
State : UT
Zip : 84003-1347
Country : US
Telephone Number : 385-482-4430
Fax Number :
Provider Business Practice Location Address
First Line : 2825 E COTTONWOOD PKWY STE 500
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-7060
Country : US
Telephone Number : 801-448-6195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2019
Last Update Date : 03/09/2026

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Directions to “ REBECCA WHITAKER JACKSON ” Practice Location

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